# An older adult with Parkinson disease develops coughing and a wet voice during lunch. Complete the immediate basic-care plan.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=546513&lang=en  
> language: en  
> subject: Nutrition and Oral Hydration  
> category: BCC

## Question

An older adult with Parkinson disease develops coughing and a wet voice during lunch. Complete the immediate basic-care plan.

The nurse should first ::선택::encourage several more sipsstop oral intakeplace the client flatoffer food through a straw, then ::선택::leave the client alone to restdocument only at the end of the shiftrestart the same meal slowlykeep the client upright and assess airway and breathing. Until the swallowing plan is clarified, the nurse should ::선택::communicate the findings and obtain swallowing assessmentremove all oral care suppliesassume the cough proves pneumoniadiscard the event as expected aging and should not ::선택::provide safe oral careuse suction if clinically neededindependently prescribe a texture based on guessworkfollow temporary precautions ordered by the team.

## Explanation

Coughing with intake, oral residue, and a wet voice suggest possible dysphagia and aspiration risk. The nurse should stop oral intake, keep the client upright, assess airway and respiratory status, provide safe oral care or suction as needed, and notify the care team for swallowing assessment. The nurse should not independently choose thin liquids, thickened liquids, or a pureed diet without an individualized recommendation because texture changes affect swallowing physiology and have benefits and burdens. Bedside signs cannot rule aspiration in or out with certainty, so the result and precautions must be communicated.

## In-depth explanation

Correct Answer
Stop the meal, keep the client upright, assess airway and breathing, and request swallowing evaluation before further oral intake.

Why It Fits
Coughing, oral residue, and wet vocal quality during intake are clinical signs that require the screen or meal to stop and risk to be reassessed.

Clinical Picture
The client is not in severe distress, allowing immediate protective care while the team determines whether additional assessment or temporary no-oral-intake precautions are needed.

Memory Link
Wet voice or cough with a bite: stop, sit up, assess, and refer.

NCLEX Rule
Do not select a food or liquid texture by guesswork; follow an individualized swallowing plan.

Why the Alternatives Fail
Continuing the meal, offering a straw, or automatically thickening every liquid can increase risk and bypass assessment of the client's actual swallowing physiology.

Sources
1ASHA Adult Dysphagia Practice Portal
2ASHA Swallowing Screening
3NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Medical unit
During a meal, the client coughs repeatedly after sips of water, food remains in the mouth, and the voice becomes wet. No individualized texture or swallowing strategy has been prescribed. The client is awake and breathing without severe distress.

## Key concepts

- **Dysphagia** — Difficulty moving food, liquid, or saliva safely and efficiently from the mouth through the pharynx or esophagus.
- **Wet voice** — A gurgling vocal quality after swallowing that may signal material or secretions near the airway.
- **Swallowing assessment** — An evaluation used to define swallowing impairment, aspiration risk, and an individualized management plan.

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